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<title>解放军第三0五医院</title>
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   <div style="width:794px;margin: 0px auto">
   		<div class="divTitle" >中国人民解放军空军航空医学研究所附属医院</div>
   		<h3 style="letter-spacing:5px;text-align: center;margin-top: 0;">护理记录单首页</h3>
   		<table class="table table-condensed table-bordered table-striped table-hover" style="width:100%;font-size: 14px;margin-top: 20px;">

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   			 	<td colspan="2">病区：</td>
   			 	<td colspan="2">床号：</td>
   			 	<td colspan="2">姓名：</td>
   			 	<td colspan="2">性别：</td>
   			 	<td colspan="2">年龄：</td>
   			 	<td colspan="2">ID号：</td>
   			</tr>
   			<tr>
   			 	<td colspan="2">民族：</td>
   			 	<td colspan="3">籍贯：</td>
   			 	<td colspan="2">文化程度：</td>
   			 	<td colspan="2">职业：</td>
   			 	<td colspan="2">婚姻状况：</td>
   			</tr>
				<tr>
					<td colspan="6">入院时间：</td>
					<td colspan="6">入院诊断：</td>
				</tr>
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					<td colspan="12">入院原因：</td>
				</tr>
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					<td colspan="12">入院方式：</td>
				</tr>
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					<td colspan="12">联系人姓名、地址、电话：</td>
				</tr>
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					<td colspan="12">入院时身体评估：</td>
				</tr>
				<tr>
					<td colspan="2">身高：167cm</td>
					<td colspan="2">体重：卧床</td>
					<td colspan="8">入院时：T&nbsp;&nbsp;&nbsp;P&nbsp;&nbsp;&nbsp;R&nbsp;&nbsp;&nbsp;BP&nbsp;&nbsp;&nbsp;</td>
				</tr>
				<tr>
					<td colspan="12">过敏史：</td>
				</tr>
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					<td colspan="3">意识：</td>
					<td colspan="3">GCS评分：</td>
					<td colspan="6">病容：</td>
				</tr>
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					<td colspan="6">言语：</td>
					<td colspan="6">体位：</td>
				</tr>
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					<td colspan="12">皮肤：异常 &nbsp;&nbsp;&nbsp;破溃<br>
					皮肤描述（部位、大小、程度）：
					</td>
				</tr>
				<tr>
					<td colspan="3">疼痛：</td>
					<td colspan="3">疼痛评分：</td>
					<td colspan="6">睡眠：</td>
				</tr>
				<tr>
					<td colspan="6">饮食方式：</td>
					<td colspan="6">营养状况：</td>
				</tr>
				<tr>
					<td colspan="12">四肢活动：<br>
						部位和程度：
					</td>
				</tr>
				<tr>
					<td colspan="12">感官功能（视、听、嗅觉功能）：</td>
				</tr>
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					<td colspan="6">排泄：</td>
					<td colspan="6">排尿：</td>
				</tr>
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					<td colspan="6">输液：</td>
					<td colspan="6">部位：</td>
				</tr>
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					<td colspan="12">引流管：</td>
				</tr>
				<tr>
					<td colspan="4">跌倒风险：</td>
					<td colspan="4">签字：</td>
					<td colspan="4">压疮风险：无 &nbsp;&nbsp;&nbsp;（诺顿评分______分）</td>
				</tr>
				<tr>
					<td colspan="12">生活自理程度：</td>
				</tr>
				<tr>
					<td colspan="12">等级护理：</td>
				</tr>
				<tr>
					<td colspan="12">医嘱饮食：普食、软食、流食、半流食<br>
						其他：
					</td>
				</tr>
				<tr>
					<td colspan="12">情绪：正常<br>
						其他：
					</td>
				</tr>
				<tr>
					<td colspan="6">对疾病认识：有 &nbsp;&nbsp;&nbsp;&nbsp;其他：
					</td>
					<td colspan="6">住院态度：积极 &nbsp;&nbsp;&nbsp;&nbsp;其他：
					</td>
				</tr>
				<tr>
					<td colspan="12">费用类别：</td>
				</tr>
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					<td colspan="12">入院护理指导：</td>
				</tr>
				<tr>
					<td colspan="12" align="right">接诊护士：王丽月 &nbsp;&nbsp;&nbsp;&nbsp;患者或家属签字：</td>
				</tr>
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   		</table>
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